Community nursing process

Nursing process in community health

1. Nursing Process in Community
Health

2. Nursing Process
Assessment
Diagnosis
Planning and outcome identification
Implementation
Evaluation

3. Scientific Method
Select/define a problem
Formulate research question/hypothesis
Collect data
Analyze data
Report results

4. Community as Client
•A community-wide group of people as the
focus of nursing service
The community directly influences the
health of individuals, families, groups,
subpopulations, and populations who are a
part of it.
Provision of most health services occurs at
the community level.

5. Nursing Process in Community Health
Nursing
The nursing process directs the CHNs in
providing care to meet a clients’ health needs,
whether the client is an individual, a family,
group or community.
Description of Nursing Process as an efficient
method of organizing thought process for
clinical decision making and problem solving

6. Nursing Process Characteristics & Community
Problem-solving process; management process; process
for implementing change
Characteristics:
Deliberative; adaptable; cyclic; sequential
Client-focused; need-oriented; goal-oriented
Interaction with community (communication,
reciprocal interaction, paving way for helping
relationship, aggregate application)
Forming of partnerships and building of coalitions

7. Community Assessment
Prior to nursing action, client is assessed to
determine his/ her health status and the need for
nursing intervention.
Assessment is “the act of reviewing a human
situation from a data base in order to affirm the
wellness state and diagnose potential client
problems; to affirm an illness state, diagnosing the
client’s prevailing problems, determining the
potential for problems and identifying the wellness
aspects of the ill client”.

8. Community Assessment
The definition of assessment indicated: -
Determination of a client’s health problem
Identification of strengths and weaknesses
and the clients state of health

9. Community Assessment
Types of data: -
Subjective or objective
Current or historical

10. Community Assessment
Data collection methods: -
Interviews
Physical examination
Review of records
Diagnostic reports
Collaboration with colleagues

11. Community Assessment
CHNs collect wider array of data than
nurses in other specialty areas
They gather data on groups of people as
well as individuals and families

12. Community Assessment and Analysis
It is a technique that may be used to determine the
health status, resources, or needs of a group of
population, through it CHN :
Determines how a community influence health
Explores the relationship between a variety of community
variables and the health of its occupants

13. Dimensions of Community Assessment
Population
Place
Social systems

14. Dimensions of Community Assessment
Population
Analyzing the characteristics of people in the
community
Size, density, composition, rate of growth or decline,
cultural characteristics, social class and educational
level, mobility, morbidity and mortality rates.

15. Dimensions of Community Assessment
Place
Where the community is located and its
boundaries
Community boundaries, location of health services,
geographic features, climate, flora, fauna, human-
made environment

16. Dimensions of Community Assessment
Social systems
Economic, educational, religious, political and
legal systems.
Human services, opportunity for recreation,
common power systems, official and voluntary
health agencies, stores and industries, safety and
communication dynamics.

17. Additional Dimensions in Community
Assessment
Socioeconomic patterns
The high indicates available health facilities
Environmental factors
Condition of houses
Crowding index
Presence or absence of electricity
Ventilation
Sanitation
Water supply
Presence of safety measure

18. Additional Dimensions in Community
Assessment
The cultural patterns
How values and beliefs and attitudes influence the health
patterns
Data about channels of communication
Data related to vital statistics
Basic to the development and evaluation of community
health programs
Data related to health patterns and health facilities
Most common diseases, vaccination programs, and health
education programs

19. Methods of Data Collection in Community
Assessment
Windshield survey
Informants interviews
Participants observation
Secondary analysis of existing data
Constructed surveys

20. Methods of Data Collection in Community
Assessment
Windshield survey
Equivalent to a simple head –to-toe assessment
Observer drives through a chosen neighborhood and uses
the five senses and observation to assess the
neighborhood
Common characteristics about the way people live
Where do they live
Type of housing

21. Methods of Data Collection in Community
Assessment
Informants interviews
Interviewing community residents: -
Key informants: Individuals in power position, such
as leaders in local government, schools, religion……
etc
General public: random residents in the community.
Random telephone or face to face
Street interviews
Interviews might be structured or unstructured

22. Methods of Data Collection in Community
Assessment
Participant observation
The CHN observe formal and informal
communities to determines signs or events
Formal community: Local government, school, board
meeting
Informal community: Coffee shop, street
Effective to assess: -
Values, norms and concerns of community
Power system and how decisions are made

23. Methods of Data Collection in Community
Assessment
Secondary Data
Assessing existing data sources: -
Records, documents and other previously collected
information
Data bases from official and non official facilities

24. Methods of Data Collection in Community
Assessment
Constructed survey
A set of prepared specific questions given to a
random sample in the community
It is time consuming and expensive

25. Nursing Diagnosis
Diagnosing client health status
The nurse identifies the client’s health status and
formulate nursing diagnosis.
The nursing diagnosis is “a clinical judgment
about an individual, family or community
response to actual or potential health problem/
life process” (NANDA, 1990)

26. Nursing Diagnosis
Nursing diagnosis includes
Classification into specific categories
Socioeconomic health status
Physiological
Psychological …………….etc.
Interpretations
Involves comparison of client-specific data with known norms and
standard
Make inferences based on data (Hypothesis evaluation) which is
possible explanation of client’s condition
Validation (Hypothesis evaluation)
Tested by collecting additional data
Verify or disconfirm

27. Nursing Diagnosis
Formulating nursing diagnosis
Diagnostic statement that may reflect positive status of health as well
as health problems
NANDA identified three types of diagnosis
Actual
High risk (Potential)
Wellness

28. Nursing Diagnosis
Structure of nursing diagnosis
Client’s state: Problem label
Etiology: The actual or the risk factors for potential
problems
Defining characteristics
The structure of wellness
Only descriptive statement
Enabling factors and strengths

29. Nursing Diagnosis
Nursing diagnosis and Community Health Nursing
CHNs develop broader range of nursing diagnosis
Individuals
Family
Group
Community
The probable cause of the problem or etiology provides
direction for problem solution
The factors identified as contributors to positive health
state indicate areas for support and reinforcement by
CHNs

30. Planning
Planning is defined as “a collaboration, orderly,
cyclic process to attain a mutually agreed on desired
future goals”.
It includes primary, secondary, tertiary preventive
actions

31. Planning
Planning consists of 6 basic tasks
1.Prioritizing nursing interventions
Clients usually with multiple health needs
Priority according:
Degree of threat to health (Maslow hierarchy)
Clients’ concerns
Ease of solution
Problem contribution to other problems

32. Planning
2.Developing goals and objectives
3.Establish criteria to achieve goals
Alternative actions to achieve goals
2.Selecting appropriate means to achieve goal
3.Designing nursing interventions
Specific statement of actions
Nurse client collaboration is needed
2.Planning evaluation
Plan how to evaluate outcomes, what data, how to collect

33. Implementation
Organizing and carrying out the plan of care
Tasks 4-6
Intervention scheme: it is four categories of nursing
interventions to direct the development of nursing
care plan: -
Health teaching
Guidance
Counseling
Surveillance

34. Implementation
Implementing nursing care
Identifying requested knowledge and skills
needed to implement the plan and identify the
most appropriate person to implement a segment
of the plan
Designating responsibility for implementation
Assign those responsible for carrying out the planned
interventions
They should have the authority to perform activities
Delegation
Referrals

35. Implementation
Implementing nursing care
Recognizing impediments to implementation
Constraints that may impede (Modify or eliminate
them)
Communicating the plan
Providing an environment for implementation
Resources (time, personnel and equipments)
Comfort (physical and psychological)
Client’s safety
Carrying out the planned activities

36. Evaluation of nursing care
It is “systematic comparison of clients’ health
status with the outcomes”.
Outcome evaluation
Process evaluation

37. Evaluation of nursing care
Activities involved are: -
 Selection of observable criteria related to the
desired goals of clients’
Collection of relevant information
Comparison of the information collected with the
selected criteria
Judgment and decision making
Feedback and modification of nursing care plan

38. Evaluation of nursing care
Possible decisions based on evaluative
findings: -
 Interventions effective and objectives were met
Objectives were not met and another approach
should be tried
No make change in quality of performance

39. Documentation of nursing process
Remember
Care not written is Care NOT DONE